MEDICARE: CALEB ADEMILOYE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R208310	MD

General Provider Information

NPI Number	:	1275182461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB ADEMILOYE

Provider Business Mailing Address
First Line	:	5636 WESTGATE RD
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-4130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 PULASKI PARK DR
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-1409
Country	:	US
Telephone Number	:	410-933-5678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	02/13/2023

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Directions to “ CALEB ADEMILOYE ” Practice Location

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